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Mr. David Amess (Southend, West) (Con): I am beginning to feel sorry for the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), who has to reply to the debate. It has been fascinating, and I certainly enjoyed the speech by the hon. Member for Sunderland, North (Bill Etherington), but I must say to the House that we have another Health Billanother piece of legislation, more regulationand we must ask ourselves: are these measures sensible and practical and will they be enforceable?
I shall start by commenting on smoking, because everyone else has. I do not smokeI do not think it is very clever to do sobut I defend to the end people's right to smoke. The question for the House is whether other people's smoking affects our health adversely. During the course of the debate, well over half of the Health Committee has been present. As the House knows, we are currently carrying out an inquiry into passive smoking, and it would be wrong for me to pre-judge that report, in spite of what the hon. Member for North-West Leicestershire (David Taylor) has said. We shall see in due course whether there will have to be a minority report. I hope that the House will have another chance to read the interesting evidence that we considered during the inquiry.
The question on passive smoking that the House must consider is very difficult indeed. I just wonder whether we are being sensible about this. I have been influenced by a variety of points that have been made in today's debate, but I shall also bear in mind the evidence that the Health Committee heard. The Minister gave evidence to the Committee, and I hope she enjoyed it, but she followed the chief medical officer, and during his evidence, as everyone now knows, he said that he came within a hair's breadth of resigning. I would simply say to the Minister that, given that this is a Government Bill, it does not look terribly good if the chief medical officer has made those remarks and is clearly in total disagreement with the Government.
I am disappointed that we have not spent much more time today talking about MRSA. These things seem to go in and out of fashion, and months ago, before the general election, MRSA was a big issue, so it would have been nice if one or two hon. Members had shared with the House their explanations as to why we have so many infections in our hospitals today. Is it because we no longer have Hattie Jacques as matron? My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries), who I believe was a nurse, will no doubt hope to catch your eye, Madam Deputy Speaker, to tell us all about it. Is it because we no longer wash our hands? It is worrying that there has been only a small drop in the number of cases since 2001, when there were 7,684. The present situation is just not good enough. I represent an area with a huge number of elderly people, and as one hon. Member said earlier, they now worry that when they go into hospital, they will come out with a life-threatening illness.
The Bill provides for the publication and enforcement of a code of practice, but as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said, the code is not included in the Bill, and until its content is revealed I am anxious about the effectiveness of the measures. It is a great shame that my party did not manage to convince the British people with our
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proposals in the general election, because I think they would have been a little bit more effective than those proposed by the Government.
I agree with my hon. Friend the Member for Beckenham (Mrs. Lait) about ophthalmic servicesI certainly share her doubts on the issue. All Members have received correspondence from their local organisations, and I am no exception. The joint Essex local optical committee has worked with our 13 primary care trusts to devise shared care schemes, providing enhanced services to diabetic patients, post-cataract cases and the visually impaired. It has worked with both ophthalmologists and primary care trusts to streamline the entry of acute cases into the hospital eye service, so that the widest choice of treatment can be offered to cataract patients. It does not oppose the proposed reforms in theory; indeed, it has proposed a clinical governance accreditation scheme for optometrists, paving the way for the new contracts. However, I believe that it is essential that the Government continue to consult optical professionals on the details of the Bill, as the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton), told the conference that she addressed in October.
Mr. Philip Dunne (Ludlow) (Con): On ophthalmic services, I urge the Minister to consider the rural aspects of ophthalmic services, currently provided by relatively small practices, and the fact that the current contract, by reducing the fees available to those small practices, puts them at risk, which is a danger to public health in rural areas.
Clauses 24 to 30 propose changes to the level of personal control held by pharmacists. Again, there has been very little mention of that in the debate, which has been entirely about smoking. The relaxation of legal procedures would free up those health care professionals so that their skills and experience could be used more widely in the community, in health centres and clinics.
Sandra Gidley (Romsey) (LD): I apologise to hon. Members for not being present for the whole debate. As the only pharmacist in the House, I know that there is a great deal of concern about the possible relaxation of the supervision arrangements. Some people regard that as an opportunity to provide more services, but what could be lost is the presence of a qualified health professional in the high street at a known time. Has the hon. Gentleman an opinion on that?
I also agree with the Royal Pharmaceutical Society in highlighting the fact that, once again, the Bill allows for much of the detail of the changes to be written into the regulations that must be carefully drafted to deliver the benefits of flexibility for supervising pharmacists, while
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maintaining patient safety and ensuring that the Bill is not a short cut to spreading pharmacists over two or three pharmacy businesses.
Part 4 addresses the deregulation of pharmaceutical services. I welcome that with caution. Several aspects of these proposals come on the back of the recommendations of the "Over the Counter" report of 2003. However, although the control of entry regulations 2003 report by the Health Committee, of which I was also a member, concludes that the current system of control of entry regulations is
"recommendations of the OTC report have the potential to make certain pharmacies unviable, potentially leaving some of the most vulnerable communities, who have the greatest health needs and are least able to travel long distances, without any local pharmacy provision, a situation that would be unacceptable."
Although it is sensible that some of the restrictions on applications for contracts to dispense NHS prescriptions should be relaxed to deliver the best possible service to NHS patients, PCTs must retain the ability to plan the provision of local pharmacy services, and any reform to the regulatory framework should be unfolded in tandem with negotiations for a new payment system for pharmacies. Competition in the pharmacy sector should be supported only if it is proven to be compatible with a planned provision of pharmacy services that ensures provision in deprived areas.
This is another Health Billmore legislation, more regulation. It is true that the Bill frees up health care professionals from the restrictive regulations and requirements of previous legislation. However, my concern in all the points that I have made is that, by reforming the frameworks in which infection control, ophthalmic services or pharmacy and pharmaceutical industries operate, the Government must be careful and consistent throughout the drafting of the regulations so that this opportunity to provide more freedom and flexibility in local health care provision is not squandered by the creation of more targets and bureaucracy, because that burden will hit the health service even more heavily, given its already over-burdensome regulation.
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